Individual
JERRY W BLAKELY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2200 IRONWOOD PL, COEUR D ALENE, ID 83814-2610
(208) 667-6486
Mailing address
2200 IRONWOOD PL, COEUR D ALENE, ID 83814-2610
(208) 667-6486
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
—
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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